Don't Overlook Your Thyroid

Too often, uninformed physicians diagnose fatigue, difficulty concentrating, unwanted weight gain, and hair loss in their patients as the inevitable results of aging. This blanket diagnosis may be flat-out wrong.

In fact, your lack of energy and inability to focus may have nothing at all to do with your age! You may simply need to adjust a thyroid malfunction.

The thyroid affects every cell in your body and is a key regulator of your energy, metabolism, heart, and bones. In her new book, The Fatigue Solution, Eva Cwynar, MD, urges readers to have their thyroid checked with a simple blood test.

Check Your Thyroid

When was the last time you went to the doctor and he checked your thyroid? You would know if he did, because to manually examine the thyroid, you have to step behind the patient and put your hands around the patient's neck as if you were going to choke her. That's the only way you can feel for the butterfly-shaped thyroid gland, which is located at the front of the neck near the collar bone (right where a man would wear a bowtie). When I introduce this examination to my patients, I always get the same reaction: "Why are you doing that? No doctor has ever done that to me before!"

You can't breathe without the thyroid, you can't think without the thyroid, you'd constantly be constipated without a thyroid, and yet it's way down at the bottom of the list of possible causes of some very common symptoms. Are you losing your hair? It could be your thyroid. Is your voice getting hoarse and raspy? It could be your thyroid. Are you always cold? It could be your thyroid. Are you having trouble concentrating? It could be your thyroid. And if it is, it's something that is easily fixed. That's why I get so angry and excited at the same time about the subject. People are suffering needlessly, some for many years, when they could be leading much more energetic, productive lives with the right diagnosis and treatment.

The Thyroid: What, Where, and How

One woman in eight will develop a thyroid disorder during her lifetime. And by the time they reach age 60, more than 20 percent of American women will have a thyroid disorder. I personally believe the numbers may be even higher because so many women haven't been officially diagnosed.

The simplest way to describe your thyroid and its function is to compare it to a furnace that is run by a thermostat (the pituitary gland). Together, they regulate how much energy and stamina you have on a daily basis. The amount of thyroid hormone you have affects how well you have slept, how you feel when you get up in the morning, and how effectively you will make it through your day.

Thyroid function affects every cell in the body. It is the main regulator of basal metabolism, which is the amount of energy needed to maintain essential physiologic functions when you are at complete rest, both physically and mentally. If your thyroid gland is not producing optimally, your cells cannot properly take in the nutrients they need, receive the right amount of oxygen, or get rid of waste materials efficiently. Thyroid hormones also affect your heart, muscles, bones, and cholesterol, to name just several of its jobs.

Introducing the 3s and 4s

There are two main hormones produced by the thyroid:

Triiodothyronine, known as T3

Tetraiodothyronine, known as T4

You may have noticed a portion of the word "iodine" in each of the hormones above. That's because the function of the thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones. Thyroid cells are the only cells in the body that can absorb iodine.

These cells combine iodine and the amino acid tyrosine to make T3 and T4.

There is one more factor we have to mention to complete this process, and that is Thyroid Stimulating Hormone (TSH), which is produced by the pituitary gland in the brain and gives that gland its thermostat-like function. So the thyroid is the furnace that provides "heat" in the form of the T3 and T4 hormones and the pituitary gland is the thermostat that goes on and off according to the amount of heat in the body. TSH tells the thyroid to raise or lower the heat.

The process goes like this:

T3 and T4 travel through the bloodstream, producing heat

The pituitary gland senses the heat; the thermostat shuts off; TSH production slows down

The body cools as the level of thyroid hormones decrease

The furnace produces more heat

When your body temperature drops, your metabolic rate drops, too. You produce less energy, and you store more calories as fat—in other words, you gain weight. You also suffer from fatigue, irritability, and the inability to concentrate.

Too Few Hormones

The most common form of thyroid disorder is hypothyroidism. Hypothyroidism occurs when the thyroid is not producing enough of its hormones. Approximately 25 million people suffer from hypothyroidism, and about half of them are undiagnosed. It is usually found in women, particularly older women; the percentage of patients with hypothyroidism is greater for women for each decade of age after age 34. That is because thyroid hormone production decreases with age.

One of the reasons that hypothyroidism often goes undiagnosed is that symptoms usually appear slowly over time, and they may appear to be signs of normal aging.

Symptoms include:

Anxiety and nightmares

Difficulty losing weight

Dry skin

Easy weight gain

Impaired concentration and memory

Menstrual irregularities

Mood swings

Severe fatigue

Thinning eyebrows

Thinning hair

Yellow skin from poor conversion of beta carotene to vitamin A

There are many women who have no symptoms and feel perfectly healthy, and yet, when tested, are diagnosed with hypothyroidism. These women need to be treated as well as those who have symptoms, because their slowed metabolism will result in adverse effects down the line. If you are not treated for hypothyroidism, you may have a heart attack because of the metabolic dysfunction that your thyroid has produced over the course of many years. That's the reason testing is so important, especially as you get older and the likelihood of hypothyroidism increases.

In the United States, the most common cause of hypothyroidism is called Hashimotos's thyroiditis. This is an autoimmune disorder—in other words, the body's immune system attacks thyroid tissue. The tissue eventually becomes so inflamed that the gland can't make enough thyroid hormone. The pituitary gland, noticing the lack of these hormones, reacts by turning up the thermostat and sending out TSH to raise hormone production. But that's no longer possible because of the inflammation of the gland. Thyroid cells start to enlarge and multiply, which will eventually cause nodules and swelling. Hashimosto's disease, like many other autoimmune diseases, is most often inherited, usually from mothers to daughters.

Too Many Hormones

When everything is functioning properly, the thyroid and pituitary work together to produce just the right amount of hormones. But there are times when the thyroid malfunctions and produces either too many or too few hormones. When the thyroid becomes overactive and produces too many hormones, you end up with a condition called hyperthyroidism. This condition affects 10 times more women than men, and usually occurs in women under 40. Here are some of the symptoms of hyperthyroidism:

Being nervous, moody, weak, or tired

Excessive sweating

Fine hair that is falling out

More bowel movements than usual

Rapid heartbeat

Red, itchy skin

Shaky hands

Shortness of breath

The most common form of this disorder is Graves' disease, which was made "famous" when first lady Barbara Bush was diagnosed with the illness in 1989 (coincidentally, her husband, President George H. W. Bush, was later diagnosed with the same disease, as was their dog, Millie). One of the stranger symptoms of Graves' disease is known as "frog eyes" where the eyeballs get pushed forward and protrude because fat builds up behind them. Graves' disease can be life threatening and can lead to heart problems if left untreated. This type of hyperthyroidism is an autoimmune disease that is genetically inherited. It causes mood and body changes when the immune system "mistakenly attacks" the thyroid gland, causing overproduction of the thyroid hormones.

People who have hyperthyroidism are often confused when they hear the diagnosis. My patients tell me, "I thought if I had hyperthyroidism, I'd be full of energy and losing weight and able to multitask like crazy! How come I'm so tired all the time?" Although this line of thinking is correct in most situations, the answer in other situations is that the overactive thyroid is burning out your body. It's affecting other organs (such as the adrenal gland) that are being compromised. It's like an engine that is constantly revving at a very high speed and going nowhere. Eventually, the parts will burn out and the engine will stop going.

Another type of hyperthyroidism is subacute thyroiditis, which involves swelling (inflammation) of the thyroid gland and is thought to be produced by a virus that usually follows an infection of the upper respiratory tract. It is often treated with anti-inflammatory drugs such as aspirin or ibuprofen to decrease both the production and the release of thyroid hormone. A beta-blocker (usually given for heart disease or hypertension or even tremor or anxiety) is also given to slow down the heart rate and make the patient more comfortable until the situation spontaneously resolves itself. This disease usually lasts for only a few months and heals itself naturally, but if left untreated can be life threatening.

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